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   2011| December  | Volume 36 | Issue 5  
    Online since April 5, 2012

 
 
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REVIEW ARTICLES
Social and Economic Implications of Noncommunicable diseases in India
JS Thakur, Shankar Prinja, Charu C Garg, Shanthi Mendis, Nata Menabde
December 2011, 36(5):13-22
DOI:10.4103/0970-0218.94704  PMID:22628905
Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. In this paper, we review the social and economic impact of NCDs in India. We outline this impact at household, health system and the macroeconomic level. Cardiovascular diseases (CVDs) figure at the top among the leading ten causes of adult (25-69 years) deaths in India. The effects of NCDs are inequitable with evidence of reversal in social gradient of risk factors and greater financial implications for the poorer households in India. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. Study in India showed that about 25% of families with a member with CVD and 50% with cancer experience catastrophic expenditure and 10% and 25%, respectively, are driven to poverty. The odds of incurring catastrophic hospitalization expenditure were nearly 160% higher with cancer than the odds of incurring catastrophic spending when hospitalization was due to a communicable disease. These high numbers also pose significant challenge for the health system for providing treatment, care and support. The proportion of hospitalizations and outpatient consultations as a result of NCDs rose from 32% to 40% and 22% to 35%, respectively, within a decade from 1995 to 2004. In macroeconomic term, most of the estimates suggest that the NCDs in India account for an economic burden in the range of 5-10% of GDP, which is significant and slowing down GDP thus hampering development. While India is simultaneously experiencing several disease burdens due to old and new infections, nutritional deficiencies, chronic diseases, and injuries, individual interventions for clinical care are unlikely to be affordable on a large scale. While it is clear that "treating our way out" of the NCDs may not be the efficient way, it has to be strongly supplemented with population-based services aimed at health promotion and action on social determinants of health along with individual services. Since health sector alone cannot deal with the "chronic emergency" of NCDs, a multi-sectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.
  7,874 1,007 6
Burden of NCDs, Policies and Programme for Prevention and Control of NCDs in India
RK Srivastava, D Bachani
December 2011, 36(5):7-12
DOI:10.4103/0970-0218.94703  PMID:22628916
Noncommunicable diseases and injuries account for 52% of deaths in India. Burden of noncommunicable diseases and resultant mortality is expected to increase unless massive efforts are made to prevent and control NCDs and their risk factors. Based on available evidence, cancer, diabetes, hypertension, cardiovascular diseases, stroke, chronic obstructive pulmonary disease, chronic kidney disease, mental disorders and trauma are the leading causes of morbidity, disability and mortality in India. Government of India had supported the States in prevention and control of NCDs through several vertical programs since 1980s. However, during the 11 th plan, there was considerable upsurge to prevent and control NCDs. New programs were started on a low scale in limited number of districts. However, there has not been any considerable change in the burden of NCDs. Based on experiences in the past, there is need to emphasize on health promotion and preventive measures to reduce exposure to risk factors. Facilities and capacity for screening, early diagnosis and effective management are required within the public health care system. Public awareness program, integrated management and strong monitoring system would be required for successful implementation of the program and making services universally accessible in the country.
  5,460 694 7
How to Effectively Monitor and Evaluate NCD Programmes in India
Anand Krishnan, Vivek Gupta, Ritvik , Baridalyne Nongkynrih, JS Thakur
December 2011, 36(5):57-62
DOI:10.4103/0970-0218.94710  PMID:22628913
Program monitoring and evaluation (M and E) are important components of any program and are critical to sound strategic planning. The Ministry of Health and Family Welfare, Government of India, launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardio-vascular diseases and Stroke (NPCDCS) with the objectives to prevent and control common noncommunicable diseases (NCDs) through behaviour and lifestyle changes, and to provide early diagnosis and management of common NCDs. M and E of program requires identification of indicators that measure inputs, process, outputs, and outcomes. The frequency of collecting information for these indicators will vary depending on the level of use and type of indicator as well as time interval over which we expect to see a change in that parameter. A group of indicators for different domains in the three major strategies has been proposed. For effective monitoring and evaluation of NPCDCS, the way forward is to finalize the list of indicators; evolve sustainable systems for surveillance; collect baseline assessment of the indicators at district level; fix targets for each indicator for different time frames; periodic review at state and national level for monitoring progress; and establish external review mechanisms. Monitoring and evaluation require complex set of co-ordinated action, responsibility for which has to be taken up by the NCD Cell within the Ministries of Health at state and national level. However, the routine data collection and compilation could be the responsibility of Central Bureau of Health Intelligence. Integrated population-based surveys with existing disease and behaviour surveillance could be undertaken by National Centre for Disease Control. The national NCD cell should compile all these information into a meaningful policy brief so that appropriate programmatic interventions can be identified. The launch of a national program to tackle the burden of NCDs is just the beginning, and the final success of the program will depend on how effectively we monitor and evaluate it.
  5,002 553 1
Research Priorities for Prevention and Control of Noncommunicable Diseases in India
Prashant Mathur, Bela Shah
December 2011, 36(5):72-77
DOI:10.4103/0970-0218.94713  PMID:22628917
India is undergoing a demographic and epidemiological transition which is influencing its health. Noncommunicable diseases (NCDs) are posing major health and development threats, while we are grappling with communicable diseases and maternal and child health-related issues. The major NCDs include cardiovascular diseases (including stroke), diabetes, cancer, chronic obstructive pulmonary diseases, mental health, and injuries. Tobacco, alcohol, diet, physical inactivity, high blood pressure, and obesity are the major risk factors common to many chronic diseases. Research on NCDs under the ICMR and through other institutions has resulted in the initiation of some national health programs such as National Cancer Control Program and District Mental Health Program. Important epidemiological descriptions have informed us on the causes and distribution of NCDs and their risk factors, including the non-health determinants (poverty, education, employment, etc) and health systems assessments, have shown the inadequacies in tackling NCDs. Several global efforts and publications have provided guidance in shaping the research agenda. The special UN NCD Summit held on 19-20 September 2011 brought the world leaders to deliberate on ways to address NCDs in a concerted manner through partnerships. In this paper the authors review the present status of NCDs and their risk factors in the country and propose a strategic research agenda to provide adequate thrust to accelerate research towards a useful outcome.
  4,303 541 4
Multi-Sectoral Action for Addressing Social Determinants of Noncommunicable Diseases and Mainstreaming Health Promotion in National Health Programmes in India
Monika Arora, Kavita Chauhan, Shoba John, Alok Mukhopadhyay
December 2011, 36(5):43-49
DOI:10.4103/0970-0218.94708  PMID:22628911
Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's "Action Plan for a Global Strategy for Prevention and Control of NCDs" calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs.
  4,363 371 1
Noncommunicable Diseases Risk Factor Surveillance: Experience and Challenge from India
M Deepa, R Pradeepa, RM Anjana, V Mohan
December 2011, 36(5):50-56
DOI:10.4103/0970-0218.94709  PMID:22628912
Noncommunicable diseases (NCDs) are reaching epidemic proportions worldwide and in India. Surveillance of NCD risk factors are therefore needed as they could help in policy planning and implementation of preventive measures. This article will focus on the experiences gained, and challenges faced, in conducting NCD risk factor surveillance studies in India. Two major surveillance studies on NCDs were conducted in India - the World Health Organization (WHO) - Indian Council of Medical Research (ICMR) NCD risk factor surveillance study and the Integrated Disease Surveillance Project (IDSP). The WHO-ICMR study was a six-site pilot study representing six different geographical locations in India with a sample size of 44,537 including rural, peri-urban/slum and urban. Phase 1 of the IDSP was completed and included seven states in India with a sample size of 5000 per state. The NCD risk factor surveillance showed that high prevalence of diabetes, hypertension and obesity in urban areas with slightly lower prevalence rates in semi-urban and rural areas. There are several challenges in obtaining data on NCD risk factors, which include challenges in obtaining anthropometric and blood pressure measures and in assessing tobacco consumption, diet and physical activity. The challenges in field operations include contacting and convincing subjects, creating rapport, tracking subjects, climatic conditions, recall ability and interviewer skills. Success in surveillance studies depends on anticipating and managing these challenges. Conclusion: Improving country-level surveillance and monitoring is a valuable step in prevention and control of NCDs in India.
  4,056 566 3
Promotion of Standard Treatment Guidelines and Building Referral System for Management of Common Noncommunicable Diseases in India
SK Jindal
December 2011, 36(5):38-42
DOI:10.4103/0970-0218.94707  PMID:22628909
Treatment services constitute one of the five priority actions to face the global crisis due to noncommunicable diseases (NCDs). It is important to formulate standard treatment guidelines (STGs) for an effective management, particularly at the primary and secondary levels of health care. Dissemination and implementation of STGs for NCDs on a country-wide scale involves difficult and complex issues. The management of NCDs and the associated costs are highly variable and huge. Besides the educational strategies for promotion of STGs, the scientific and administrative sanctions and sanctity are important for purposes of reimbursements, insurance, availability of facilities, and legal protection. An effective and functional referral- system needs to be built to ensure availability of appropriate care at all levels of health- services. The patient-friendly "to and fro" referral system will help to distribute the burden, lower the costs, and maintain the sustainability of services.
  3,942 597 -
What are the Evidence Based Public Health Interventions for Prevention and Control of NCDs in Relation to India?
Kavita Singh, K Srinath Reddy, Dorairaj Prabhakaran
December 2011, 36(5):23-31
DOI:10.4103/0970-0218.94705  PMID:22628907
The accelerating epidemics of noncommunicable diseases (NCDs) in India call for a comprehensive public health response which can effectively combat and control them before they peak and inflict severe damage in terms of unaffordable health, economic, and social costs. To synthesize and present recent evidences regarding the effectiveness of several types of public health interventions to reduce NCD burden. Interventions influencing behavioral risk factors (like unhealthy diet, physical inactivity, tobacco and alcohol consumption) through policy, public education, or a combination of both have been demonstrated to be effective in reducing the NCD risk in populations as well as in individuals. Policy interventions are also effective in reducing the levels of several major biological risk factors linked to NCDs (high blood pressure; overweight and obesity; diabetes and abnormal blood cholesterol). Secondary prevention along the lines of combination pills and ensuring evidenced based clinical care are also critical. Though the evidence for health promotion and primary prevention are weaker, policy interventions and secondary prevention when combined with these are likely to have a greater impact on reducing national NCD burden. A comprehensive and integrated response to NCDs control and prevention needs a "life course approach." Proven cost-effective interventions need to be integrated in a NCD prevention and control policy framework and implemented through coordinated mechanisms of regulation, environment modification, education, and health care responses.
  3,545 433 1
Integrating Services for Noncommunicable Diseases Prevention and Control: Use of Primary Health Care Approach
Jai P Narain
December 2011, 36(5):67-71
DOI:10.4103/0970-0218.94712  PMID:22628915
Noncommunicable diseases (NCDs) are now the leading cause of death in the South-East Asia Region, accounting for 55% of all deaths annually. Besides presenting a serious threat to public health, NCDs hamper socioeconomic development in the region. The situation is likely to worsen in the future. Fortunately, cost-effective and high-impact interventions to prevent and control NCDs are, however, available and at individual level, they cost next to nothing. In order to ensure that these interventions are delivered in an efficient and effective manner and have the desired impact especially in light of the prevailing economic difficulties, an integrated approach is necessary. Different approaches to integration can be used although integrating NCD interventions into the health system based on primary health care remain the best model.
  2,900 308 -
REPORTS
Key Recommendations of High-Level Expert Group Report on Universal Health Coverage for India
JS Thakur
December 2011, 36(5):84-85
PMID:22628920
  2,429 230 1
REVIEW ARTICLES
Strengthening the Health System to Better Confront Noncommunicable Diseases in India
Antonio Duran, Anagha Khot,
December 2011, 36(5):32-37
DOI:10.4103/0970-0218.94706  PMID:22628908
The paper emphasizes the vital need to address the rising burden of noncommunicable diseases (NCDs) in India with a health systems approach. The authors argue that adoption of such approach may soon be imperative. Applying the health systems framework developed by the WHO in 2000 to NCDs means in summary re-examining the planning and organization of the entire health system, from service provision to financing, from information generation to ensuring adequate supply of pharmaceuticals/technologies or human resources, from improving facility management to performance monitoring. Using this framework the authors seek to highlight core issues and identify possible policy actions required. The challenge is to ensure the best implementation of what works, aligning the service provision function with the financial incentives, ensuring leadership/stewardship by the government across local/municipal, state or regional and national level while involving stakeholders. A health system perspective would also ensure that action against NCD goes hand in hand with tackling the remaining burden from communicable diseases, maternal, child health and nutrition issues.
  2,190 272 1
Role of Medical Education in Preventing and Control of Noncommunicable Diseases in India?
KK Talwar, Ashoo Grover, JS Thakur
December 2011, 36(5):63-66
DOI:10.4103/0970-0218.94711  PMID:22628914
India has approximately 335 medical colleges, which produce around 40,000 medical graduates annually. Even though medical professional have a critical role in prevention and control of noncommunicable diseases (NCDs) including injuries, it has been observed that the present medical and nursing curriculum in India does not adequately cover prevention and control of NCDs. The topics for specific approach to prevent NCDs and various strategies can be incorporated into public health and clinical courses in undergraduate medical education, with brief optional courses in residency and continuing medical education for established practitioners. High-level expert group instituted by Planning Commission of India on Universal Health Coverage recommended that medical education requires greater orientation of providers to the social determinants of health as well as to gender and equity issues. Curricula in medical schools should keep pace with the changing dynamics of public health, health policy, and health demographics. Medical education and training should be reoriented by introducing competency-based, health system connected curricula, and continuous education. There is a need to review of medical curriculum, introducing innovative integrated teaching methods, and capacity building of teachers for meeting the challenge of rising burden of NCDs in India.
  2,133 290 -
SHORT PAPER
Trend of Tobacco Use and Exposure to Secondhand Smoke Among Students Aged 13-15 Years in India and Selected Countries of the South-East Asia Region
Dhirendra N Sinha, Poonam Khetrapal Singh, JS Thakur
December 2011, 36(5):78-80
DOI:10.4103/0970-0218.94714  PMID:22628918
  2,184 183 3
VIEW POINT
Relevance of Primary Health Care in Controlling Noncommunicable Diseases in India
Deoki Nandan, Vivek S Adhish, Neera Dhar
December 2011, 36(5):4-6
DOI:10.4103/0970-0218.94702  PMID:22628910
  1,747 268 -
EDITORIAL
Road Map and Challenges for Universal Coverage for Prevention and Control of Noncommunicable Diseases in India
Nata Menabde
December 2011, 36(5):2-3
DOI:10.4103/0970-0218.94701  PMID:22628906
  1,491 189 -
REPORTS
New Delhi Call for Action

December 2011, 36(5):81-83
PMID:22628919
  1,421 118 -
MESSAGE
Message from His Excellency the Minister of Health and Family Welfare, Government of India
Ghulam Nabi Azad
December 2011, 36(5):1-1
PMID:22628904
  1,290 103 -
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